1. HSC Complaints Procedure
What are our practice responsibilities
New standards and guidelines for resolution and learning came into effect on 1st April.

2. HSC Complaints Procedure
New standards and guidelines came into effect 1st April 2009
Main changes
Enhanced local resolution
Removal of independent review
New standards for complaints handling
This is what is called a single tier process and allows for access by the complainant to the NI Commissioner for complaints (the Ombudsman, Currently Tom Frawley) following failure of local resolution.
For us this means that there will be a need for increased attempts to resolve complaints within practices satisfactorily and as quickly as possible..
The new procedure will replace existing guidance for general medical practices 1996.

3. Definition “An expression of dissatisfaction that requires a response”
Complaint
“An expression of dissatisfaction that requires a response”
How do we in general practice define a complaint, is it the patient who tells you they have been trying to get through on the phone for 10 minutes but it is engaged? Or the person who has been waiting for 20 minutes after their appointment time? Or the person who was given the wrong medication? Or was misdiagnosed by the doctor?
All of these are legitimate complaints but some of them can be dealt with informally without going through the full procedure, sometimes all the patient wants is an acknowledgement and an apology. NB you should always apologise this does not mean that we are wrong, we apologise for the fact that the patient believes they are hard done by or hurt in some way and promise that their complaint will be investigated and we will let them know what the outcome is, this may just be that we give staff refresher training or that we change our way of recording things etc
Sometimes patients may offer comments or suggestions that are extremely helpful.
Most complaints are about: Clinical diagnosis, Quality of care, Staff attitude or Communication problems

4. How will these changes affect us?
When managing complaints we should
Support the complainants in expressing their concerns
Explain the options available to them
Be courteous and sympathetic
Recognise that complaints are a valuable source of learning for the practice
We talk to the patients and try to get the full facts of the circumstances surrounding their complaint, if necessary get statements from other involved people. Clarify with them exactly what their complaint is and try to find out what resolution they expect.
Explain our complaints procedure to them and tell them what they can do if they feel we have not resolved the situation to their satisfaction.
Always be calm and polite even if they are shouting at you (the quieter we talk will mean that the patient has to shut up to hear us) If they are creating a scene ask them to go into an empty room to discuss further – leave the door open if you are afraid of the person complaining.
We should not take complaints as a negative reaction to what we do but look on it as a learning and improvement process. I am sure there has often been times in your life that someone has shown you a different way to do something that has made things easier for you or improved the way you do things, if you treat complaints with the same attitude it can be turned into a positive and ensure no one else complains and so improves the service we offer.
Good Practice Principles (DHSS 2004) for front line staff dealing with complaints.
These are good practice principles for anyone handling a complaint either a verbal complaint or written complaint but are particularly for front line staff.
A lot are common sense and common courtesy – how we would all like to be treated. Treat with respect & dignity.
Identify yourself – politeness to always introduce self.
Listening carefully – find out the real nature of the problem – person may be anxious/upset & find difficulty expressing their issues. Take the extra couple of moments – it will pay off.
Helpful, sensitive, courteous – complainants want to be taken seriously; offer to help; show you want to help; stay calm and empathetic; DON’T argue back! Try to defuse the situation. (Be aware of local arrangements re how to deal with aggressive situations)
Confidentiality – discuss protection of patient / client confidentiality; ensure patient/client agreeable to discussions about them – consent / authorisation.
An apology can often resolve matter quickly. Its ok to say sorry!
Take ownership – attempt to find a solution but DON’T “jump in” with solutions until you are sure you have heard and understood their complaint – people often initially only want someone to listen to them – get something “off their chest”. Check details. Ask what they would like to happen. Agree actions. Emphasise resolution is best as quickly as possible and as near to the point of contact as possible. Don’t make promises you can’t keep. Don’t blame others or policies.
Ask for help from someone else, e.g. line manager, supervisor, colleague etc, if in doubt; you are unsure how to handle; ‘out of your depth’ or indeed to provide you with support.
If a complaint raises a specific urgent concern or risk, ensure the patient/client’s immediate needs are met before looking at the other aspects of the complaint.
Do you know who the designated person is for managing complaints within your organisation? And how to contact them?
Ask staff to ensure that leaflets on how to make a complaint are displayed in all public areas/facilities. (show or give copies of your organisation’s leaflets)
If staff have dealt with a verbal complaint, discuss how they are expected to document and report this within individual organisation – if there is a form, provide with copy for reference. If complainant still unhappy, advise of the formal process and provide with a complaints leaflet.
A good service is everyone responsibility!
Treat others as you would like to be treated yourself!
Choose your behaviour carefully – use it; don’t lose it!
Staff can be part of the solution not part of the problem!

5. What are the Principles?
Openness and accessibility
Responsiveness
Fairness and independence
Learning and improving
The staff should always be willing to take complaints on board and support the complainant and help them by discussing the process with them so that they understand the principles and the timelines involved.
We aim for early resolution to reduce stress for all concerned: be objective and positive and do not adopt a defensive manner/tone or negativity or them v us: working together openly and honestly.
As previous slide

6. Complaints Manager
The complaints manager is the person within the practice who will investigate the complaint – usually the practice manager or lead GP.
If the complaints manager is off then another member of staff should get as much detail as possible and ask one of the other GP’s to deal with it or ask the person if they are happy to wait until the complaints manager is back to deal with it. (this should only be done if complaints manager is off for a day or two not if it is over a week)

7. Role of Complaints Manager
Deal with complaints referred by front-line staff
Be available if someone wants to complain
Provide support to staff
Take account of all evidence relating to the complaint
Ensure the complaint is investigated fairly and impartially
Keep records of all paperwork relating to complaint
Be aware of time regulations when dealing with complaints
Treat all information received with confidence
The complaints manager only needs to be involved if the complaint is serious enough to warrant further investigation but must be made aware of all minor complaints and their resolution.
They should be available if the person complaining does not want to deal with one of the front-line staff or clinicians
They need to be able to make judgements as to whether the patient has a genuine complaint or if it is something which fall outside our remit e.g. something relating to secondary care
Ensure all relevant evidence, including medical records if appropriate are available
All issues complained about must be addressed in the draft response to the complainant, the complainant should always be kept informed of the progress of the investigation
Use records of complaints received to monitor service in the practice and make changes
Timescales – Complaints should be made within 6 months of the event or 6 months after becoming aware of the cause for complaint but no longer than 12 months after the event
If someone complains they should receive a letter acknowledging the complaint within 3 working days
The complaint should be investigated and a response sent to the complainant within 10 working days.

8. Promoting Access
Patients should be aware of their right to complain and given support if they do.
Leaflets, Posters, Notices etc should be clearly visible in patients waiting area
Staff should be aware of the practice protocol for dealing with complaints
Complaints leaflets and/or Posters/notices should be clearly displayed in the patient waiting area.
All staff need to be trained and fully aware of their roles and responsibilities if a patient makes a complaint.
How we handle complaints is an indicator of how responsive we are to our service users

9. Front Line Response
If a patient comes to the front desk/surgery to complain then the person taking the complaint should
Listen and apologise
Offer them a copy of complaints leaflet
Ask if they wish to complete a formal complaint form
If not, ask them if you can take down the details informally so that we can improve our service
Pass the details on to the complaints manager.
Ensure all relevant details are included
Keep all details confidential
Listen to the complaint right through As I said before you apologise to the person complaining because they have not had the service they expected not because you are admitting we were wrong.
Copies of the complaints leaflet and complaints forms should be held at reception so that staff do not have to go searching for them.

10. What Happens Next? Can the complaint be resolved on the spot
Record the details
Get statements from other staff involved
The complaints manager will investigate
Findings are reported back to the complainant
Records should be kept of all paperwork
Anonymised copies of all paperwork should be sent to the local Health and Social Care Board
The complaint may be minor e.g. Wet Floor, draughty with door open etc and can be dealt with immediately
Other times the patient may not want to record the complaint as they ‘were only saying’ and it doesn’t really matter they do not want to put their name to it, at this stage we still record it but without the patients name and we tell them it is part of our continuous improvement to give patients a better service.
If it is more serious then it needs to be recorded and fully investigated using the practice protocol.
Details that need to be recorded are: Patient Number, Name and contact details, who or what is being complained about including names of staff if known. Where and when the events of the complaint happened. Where possible what remedy is being sought e.g. apology, explanation or changes to the services.

11. Who Can Complain A patient Former patients
Someone acting on behalf of existing or former patients
Parents on behalf of a child
Next of kin to someone who has died
If someone is acting on behalf of a patient or former patient then they must have that persons consent.
Parents or persons with parental responsibility can act on behalf of a child.

12. How To Investigate a Complaint
Be clear what you are investigating
Make sure that the complainant agrees
Put a plan in place to focus on key issues
Document any evidence
Hold interviews if necessary
Review all evidence and summarise
Reach a conclusion and make recommendations
Let the complainant know how to proceed if they are not happy with the outcome
It is a good idea to talk to the complainant as early as possible, this can help you to define the investigation from their perspective the gap between what happened and what should have happened, it provides an opportunity to clarify what they would like to see happen and to manage any realistic expectations and can help to obtain any information or documentation needed
Things to consider when writing a plan include:
What happened? What should have happened? What are the differences between these two things?
Any background information essential for understanding the complaint – this may need to come from the practice or the complainant
What was the impact to the patient? What should be done to put things right? What should be done to prevent a recurrence?
Documentary evidence is the main source of information for an investigator, the evidence should be complete, relevant and understandable.
Sometimes a someone who has given evidence may need to be interviewed to clarify some point in their evidence if this happens the interviewee needs to know in advance that they will be interviewed and you need to have your questions prepared so that they know what you will ask them, they can also be allowed to have a witness present, the interview should be held in a private room with no interruptions
When all evidence is reviewed we need to see if the complaint was based on a reasonable assessment of what should have been provided by the organisation. We need to identify all points of agreement and disagreement and summarise these.
When we reach a conclusion it is a good idea to check that these tally with our plan of what we were investigating
When making recommendations it is essential to think about the failures that have led to the complain e.g. Human error, poor application of resources, admin problems, practice failing to understand or accept its responsibilities.
The investigation must be robust and follow the correct procedures and any recommendations should be practical and realistic, if the complainant is still not happy advise them of how they can take their complaint to the next level.

13. How Complaints Can Be Made
Verbally – face-to-face
By telephone
By letter By

14. Monitoring of Complaints
The practice is required to provide the HSCB with copies of all written complaints received
The complaint must be acknowledged within 3 working days of receipt.
Quarterly returns must be sent to the board of all other informal complaints
The practice must acknowledge the complaint within 3 working days and the complaint should be responded to within 10 working days.

15. Practice Monitoring of Complaints
The practice should have regular meetings to review complaints
This will help to identify trends and improve quality and safety
Lessons should be learned and change implemented where necessary
Promote a culture of learning from complaints
Why do complaints matter?
To the Organisation:
Identify risks, Learn lessons, Improve services, Reputation, Make case for more resources,
To the Service User:
Public accountability, Restore confidence, Address negative feelings, Closure, Improvement, Valued / worthwhile

16. Ombudsman Contact details
Mr Tom Frawley
NI Ombudsman
Progressive House
33 Wellington Place
Belfast
BT1 6HN
The ombudsman will only get involved if the complaint cannot be resolved at local level or if the complainant is not happy with the resolution offered.

17. Complaints Manager Rosemary Henderson Health & Social Care Board
Gransha Park House
Londonderry

18. Any Questions?